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Too much chemotherapy

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Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.

I find myself constantly at odds with optimistic oncologists with the "never say die" spirit, despite evidence of tumour progression and patients' problems with side effects. Too much chemotherapy is of course expensive but the main thrust is the patients' well being or lack thereof. To give an example of optimism: I have done bypass operations for patients with obstructed, non-resectable colon cancer and widespread mets. The next step of course is a visit to the oncologist. I prepare the family not to expect too much. To my dismay, when I see the patients on their following visit with me they are bubbling with confidence after the oncologist has assured them of a 10 year survival. To cut the story short, they are often dead within a year. We need to know our limitations and when to stop playing God.

Excellent piece. Summarises what many of us have felt over the last decade or so. Medical oncologists tend to work on the fear of death that their patients vocalise. This results in a biased opinion towards chemotherapy that often communicates unrealistic benefits. In my opinion, the risks and benefits of chemotherapy must be explained to the patient by an independent specialist who is not directly involved in the care plan. Then alone would it be a true informed consent. This article brings back Richard Smith's blog writing that kicked up a furore in 2014.

Congratulations on this timely and courageous editorial. It brought to mind the haunting words of Sherwin Nuland, in his book "How we die". (1)

"Almost everyone seems to want to take a chance with the slim statistics that oncologists give to patients with advanced disease. Usually, they suffer for it, they lay waste their last months for it, and they die anyway, having magnified the burdens they and those who love them must carry to the final moments."

Healthcare is hell. The more we get, the worse we feel. Sadly, doctors don’t know that trusted toxins and addictions are common, covert causes of sickness. So healthcare is a vicious cycle of toxins, addictions, and sickness, in which doctors first overlook the toxic, addictive causes of sickness, and then prescribe toxic, addictive drugs. I call this pervasive vicious cycle the “Toxic Craving Cycle”, since craving reflects addiction. Sadly, healthcare makes us sick, by burying us under layers of trusted toxins (vaccines, antibiotics, statins, psychotropics, chemotherapy) and addictions (sugar, chocolate, vanilla, caffeine, cola). To quote GB Shaw, "Science never solves one problem without creating ten more."

I would like to congratulate Dr Godlee, Dr Wise and Dr Nicholson for their contributions. They are very insightful and have, once again emphasized the need for patient/doctor discussion.

While I am sure that most GPs and consultants do discuss the problems with patients to an extent, this is often confused, as Dr Godlee states: “patients are being badly misled by over-enthusiastic accounts of what chemotherapy can achieve. Many expect a cure. In reality they will gain on average only a few months of extra life.” This is often the attitude taken by charities in promoting new expensive therapies.

From Dr Wise’s report I find the following statement:
“.............the contribution of cytotoxic chemotherapy to five year survival in 250 000 adults with solid cancers from Australian and US randomised trials. An important effect was shown on five year survival only in testicular cancer (40%), Hodgkin’s disease (37%), cancer of the cervix (12%), lymphoma (10.5%), and ovarian cancer (8.8%). Together, these represented less than 10% of all cases. In the remaining 90% of patients—ncluding those with the commonest tumours of the lung, prostate, colorectum, and breast—drug therapy increased five year survival by less than 2.5%—an overall survival benefit of around three months.”

While not having cancer I find these numbers distressing. A quick calculation using these numbers suggest that at best something like 1 in 23 patients (p < 0.05) with cancer will actually survive longer than five years and that this is largely due to early diagnosis rather than expensive therapy. Clearly, for those with the most common cancers (90%), this reduces to 1 in 40-50 surviving > 5 years. The number actually dying in the next 5 years is not reported. As a non-medic, this is not the impression I get from the MSM advertising and promotions.

Truthful advertising rather than Big Pharma astroturfing with inflated HRs (while significant) would seem to be appropriate for everyone's benefit.

Also there is Warburg’s hypothesis of the metabolic cause of cancer promoted by Dr Siegfried’s Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer, Christofferson’s, Tripping Over the Truth: The Metabolic Theory of Cancer, a very readable review and the research of Pedersen and Ko on the use of 3-BPhttps://www.ncbi.nlm.nih.gov/pubmed/22382780/

Unfortunately 3-BP is not patentable and can be purchased on the internet at prices like £75 for 10 kg; both factors do not provide a “perceived level” of profit required so research does not receive grants. One suspects that “profit” is the driving force behind current research; patients are merely guinea pigs towards that objective.

To end I quote Dr Godlee:
Only then will cancer care serve patients rather than governments and industry.